Our Forms Brand new Patient Forms to complete PLEASE FILL OUT ALL OF THE FORMS (Family information, Patient medical history, HIPAA/Financial agreement, Informed Consent, COVID-19) Family information (1 form per family) Patient medical history (1 form per child) HIPAA and Financial agreement form (1 form per family) Please read HIPAA information and Dental material below Informed Consent form (1 form per family) Other consent forms (to be filled out only if our team instructed you to do so) Non-parental consent Silver Diamine Fluoride (SDF) Infant Tongue/Lip tie release consent Child Tongue/Lip tie release consent Inform consent (other) Evaluation forms (to be filled out only if our team instructed you to do so) Pediatric Sleep Questionaire (PSQ) Infant Tongue/Lip tie assessment Child Tongue/Lip tie assessment Information for reading Health Insurance Portability and Accountability Act (HIPAA) Dental Material First Aids for Dental Emergencies Caries balance Contact us! Call us: (707) 685-9819 ORText us: (707) 474-4543 ORFill out the form below Which is bigger, 2 or 8?
